Provider Demographics
NPI:1710437637
Name:FLEMING & BARNES, INC.
Entity Type:Organization
Organization Name:FLEMING & BARNES, INC.
Other - Org Name:DIMONDALE ADOLESCENT #4
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-791-3064
Mailing Address - Street 1:PO BOX 4446
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9595
Mailing Address - Country:US
Mailing Address - Phone:310-791-3064
Mailing Address - Fax:310-791-3084
Practice Address - Street 1:1461 N ANAHEIM PL
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3209
Practice Address - Country:US
Practice Address - Phone:310-791-3064
Practice Address - Fax:562-494-1063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLEMING & BARNES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-04
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197804638322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children